Ah medical school - years of looking at stuff and not knowing what it means, but pretending you do. But then final year rolls around and you realise you actually HAVE to know what stuff means. Well. I didn't see that coming, did you?
How To Interpret A Chest Radiograph (without getting cross-eyed)
The X-ray has essentially 5 shades of grey, which is why they make for riveting viewing:
BLACK = Gas
DARKER GREY = Fat
LIGHTER GREY = Soft Tissue
WHITE = Bone
BRIGHT WHITE = Man-made
The Interpretation comes in 3 part
1)
The Spiel - the boring, but necessary details
2)
The Film - the technical quality
3)
The Chest - the actual findings
Firstly
the spiel, this sounds well impressive if done slickly, but essentially you're just reading out loud..
a) Type of Projection + Any specific techniques
b) Name of Patient
c) Age/DOB of Patient
d) Date Taken
e) Location Taken
"e.g. This is a (1)PA film of (2)Mrs - , a (3)56 yr woman, taken on the (4)--/--/-- in (5)A&E, after she presented with..."
Types of Projection:-
PA/AP/Lateral/Supine/Erect/Semi-Erect (the patient is upright, but not in an ideal position) and Mobile.
Techniques include if it was taken in expiration etc.
Secondly,
the film, where we get to criticise x-ray technicians when they can't hear us.
Morbidly we use the acronym RIP to assess these,
Rotation
Inspiration
Penetration
Then
the chest, remember not to get too excited at this bit, though it's what everyone's been waiting for.
First - the weird thing you can't stop looking at. Calling it such is not so good, but cleaning it up as "the most striking abnormality on initial assessment is..." Continue on that system if ti feels natural - otherwise go for...
Airway - assess the trachea, mediastinum and the hila
- Deviation of trachea
- Width and contour of mediastinum
- Size and density of the hila
- Level and symmetry of the hila
Breathing - Lungs and pleura
- Size
- Parenchyma
- Vascular Lung Markings
- Pleural thickness or calcification
- Opposition against chest wall e.g. pneumothorax
Circulation - Heart and major vessels
- Heart size, size of chambers
- Outlines of aorta, IVC and SVC
- Man-Made stuff e.g. stents, clips, wires, valves, pacemakers
- Size of pulmonary vessels
Denser stuff (yeah, it doesn't totally work) - Bones and soft tissues
- Bone disease, fractures, bony deposits
- Surgical Emphysema
- Breast presence/absence/symmetry
2) Then the
Review Areas otherwise known as the stuff you forget.
From top to bottom...
Apices
Behind the Heart
Breast Shadows
Costophrenic Angles
Below the
Diaphragm
... which sort of works.
Remember!!
ALWAYS compare to a previous x-ray if possible.
The X-ray is a 2D image of a 3D structure.
Never stop looking for stuff!! Make the examiner bored!! Still be there when the lights are off and everyone has gone home!!
